Physical Therapy

Chronic Pain: What We Know And How To Manage It!

Chronic Pain

It’s important to note that all pain is real! Chronic pain is not “all in your head.” It is pain that persists beyond the acute stage (greater than two months). It often occurs independent of actual tissue damage, meaning that there is no damage to muscle, tendon, ligament, bone, etc that is causing the pain.

Chronic pain involves changes that occur within the brain in response to pain that lasts for long periods of time. Areas in the brain that are not associated with perceiving pain begin to perceive signals as pain – meaning that activities that should not cause pain are now painful! This can significantly affect the quality of one’s life.

Chronic pain affects almost 1 in 3 people worldwide! The cost in the US is about $600 billion annually for medical treatment, lost wages, and lost work time. Chronic pain is the most common reason to seek treatment and the most common reason for disability and addiction. The cost of treatment for chronic pain in the US is even greater than those for cancer, heart disease, dementia, and diabetes care.

Currently, chronic pain is not managed well by healthcare providers. A common treatment is the use of opioids. Opioids (e.g. codeine, morphine, hydrocodone (Norco), oxycodone, fentanyl) are meant for short term management of acute pain. They are not meant for long term management of chronic pain. Medication alone cannot treat chronic pain. When other treatments are added in addition to medication, outcomes are shown to be better. Some people on long term opioid treatment actually experience the side effect of hyperalgesia (or hypersensitivity) which increases pain!

How to Manage

There are several other ways to manage chronic pain in addition to medication.

Exercise – start with light, painfree activities and increase as you are able

Reduce stress as stress causes increased inflammation which can lead to increased pain

Learn more about your condition – learn how others manage to control their pain and maintain their function

Keep up with normal activities as much as possible

Improve your overall health

Avoid bed rest and inactivity – Bed rest will not improve your pain and may make it worse, as it leads to other problems such as weakness, weight gain, and poor circulation.

Consume an anti-inflammatory diet
– Emphasizes plant-based foods and anti-inflammatory spices: turmeric, ginger
– Nutrient deficiency is common in chronic pain and can be worsened by long term use of analgesics (common deficiencies include vitamin D and magnesium)
– Make sure you have the correct intake of omega 3 fatty acids

Make sure you are hydrated
– Dehydration can amplify chronic pain symptoms such as headaches, muscle aches, joint stiffness, and fatigue
– Proper hydration is key in managing pain and improving our body’s function
– Caffeine intake to address loss of sleep, fatigue, and headaches can contribute to dehydration
– The recommendation for appropriate amount of water varies but 64 oz is a great place to start

Make sure you are getting enough sleep
– Position modification
– Stretching before bed
– See if there are other factors other than pain that are contributing to loss of sleep
– Caffeine intake
– Stimulants such as light or noise
– Use of cell phones or other electronics prior to bed

Physical therapy or occupational therapy to increase strength, increase mobility, and improve function as well as to address pain

Be your own advocate when seeking treatment. Only you know what you are feeling and how it affects you. Work to find the treatment that is best for you!

This blog was specially written by our friend and guest writer Rachel Zimmerman, DPT.

Rachel is clinic director at ATI Physical Therapy in Green Bay, WI. You can find out more about her clinic or find a location near you at ATIpt.com!

Dry Needling for Joint and Muscle Pain Relief

What is Dry Needling?

The name “dry needling” comes from studies that were done to determine the effectiveness of injections. The studies showed that just putting a needle into a trigger point (a small, tight, tender area in a muscle) was just as effective as injecting a pain relieving or anti-inflammatory medication into the trigger point. Since nothing is injected with dry needling, we refer to it as “dry.”

Is Dry Needling the Same as Acupuncture?

While the two are often confused, they are actually different treatments. Dry needling is performed in the dysfunctional area, whereas acupuncture may be performed in the hand to address a headache, for example. Dry needling also focuses mainly on the treatment of musculoskeletal conditions.

How is Dry Needling Done?

First, the area of pain or tension will be assessed in order to locate trigger points. Then a needle will be placed into the muscle, and then the needle will be moved around in small movements that cause the muscle to activate – seen or felt as a twitch in the muscle. Once the twitching ceases, the needle is removed from the muscle.

What is the Purpose of Dry Needling?

Dry needling helps to relieve pain, help muscles relax, and improve function. Usually dry needling is used on tense muscles that are causing pain and affecting a person’s function. It is a very effective method and the results can be seen quicker than other treatments such as massage. The effects of dry needling can be felt after just one session but may take more than one to fully resolve the issue. It is used in conjunction with other treatments such as manual therapy and exercise.

Is Dry Needling Safe?

The risks associated with dry needling are minimal which makes it a safe procedure when performed by a trained practitioner. Physical therapists are regulated by each state in the training they must receive for dry needling before they can use the treatment on patients. Physical therapists also use clean technique, meaning they wear gloves and make sure that they use hand sanitizer and alcohol to sanitize the area being needled. Also, needles are kept in sealed packaging until use so that they are sanitary and safe for use. After a single use they are disposed of in a sharps container and are never reused.

Does Dry Needling Hurt?

Every person is different, and each muscle responds differently to dry needling. The process can be uncomfortable, but is usually not painful. The needle used for dry needling is a very thin needle similar to those used for acupuncture, so there is usually no pain associated with the needle being inserted into the skin. The muscle twitches associated with dry needling can be uncomfortable but typically are not painful. There may be some lingering soreness afterwards but this usually lasts less than 24 hours. Drinking plenty of water after having dry needling done can help to lessen this soreness.

Is Everyone Appropriate for Dry Needling?

While dry needling is a very effective and safe procedure for most people, not everyone is a candidate for it. There are certain precautions that can affect someone’s ability to have dry needling done (for example, over the area of a pacemaker). There is also a timeline of when dry needling is appropriate after surgery so that there is no increased risk for infection. Talk to your physical therapist to see if you’re appropriate for dry needling.

This blog was specially written by our friend and guest writer Rachel Zimmerman, DPT.

Rachel is clinic director at ATI Physical Therapy right here in Green Bay, WI. You can find out more about her clinic or find a location near you at ATIpt.com!

What You Need to Know: Plantar Fasciitis

Today’s blog post is courtesy of a special guest writer and expert on the topic of Plantar Fasciitis: Rachel Zimmerman DPT.

If you’ve ever experienced pain in the bottom of your foot, or in your heel, chances are it’s Plantar Fasciitis.

There is a common misconception that this is something you have to live with, but you don’t! The following advice will help alleviate your pain and get you back on your feet.

What is Plantar Fasciitis?

To understand what this condition is, we need to break it down into parts: plantar fascia and -itis. The plantar fascia is a structure in the bottom of the foot. It is a thin, white tissue similar to a ligament that sits between the skin and the muscle and extends from the heel to the toes. It provides stability to the foot. The suffix “-itis” is a Greek term meaning inflammation. So plantar fasciitis is inflammation of this tissue in the bottom of the foot.

What are the Symptoms of Plantar Fasciitis?

Plantar fasciitis typically presents as pain in the heel, usually on the inside part of the foot. The pain can also spread along the arch and along the bottom of the foot. The pain is usually worst during the first few steps after getting out of bed in the morning but can also occur after standing or walking for long periods of time.

What Causes Plantar Fasciitis?

Plantar fasciitis has multiple causes, but one of the most common is increasing your activity level too quickly! Also, having tight calf muscles, weak foot muscles, and/or wearing improper footwear.

What do I do if I believe I have plantar fasciitis?

Avoid aggravating activities: The most important thing you can do when you have an inflammatory condition is to avoid activities that increase your pain. Figure out which activities are aggravating it and modify them as you can. This does not mean to avoid activity altogether – just find activities you can do that don’t increase your pain level. This does not have to be long term, just while you are experiencing pain.

Stretch your calves: Tight calf muscles (the gastrocnemius and soleus muscles) can contribute to inflammation in the plantar fascia. Stretch your calves by sitting with your feet out in front of you with your knees straight, and place a towel around the ball of your foot. Pull back on the towel towards you until you feel a stretch in the calf. Hold for 30 seconds and then repeat a few times. You should feel a stretch, but not pain.

Strengthen your foot muscles: There are specific muscles in your foot that help to support your arch and take stress off the plantar fascia.

   • Great toe extension: Lift big toe, leaving other 4 on the ground. Repeat for 3 sets of 10.

   • Small toe extension: Lift 4 smaller toes, leaving big toe down. Repeat for 3 sets of 10.

   • Doming: Raise the arch of your foot, keeping toes down. Repeat for 3 sets of 10.

Change your footwear: Avoid shoes that are flat as these do not support your arch and can contribute to stress on the plantar fascia. Look for shoes that have a buildup on the inside of the shoe where your arch would be. Most shoe stores will be able to help find footwear that is appropriate for your feet, whether you need a stability shoe (which has more arch support than normal) or a neutral shoe (which has arch support but not as much as a stability shoe).

Ice: You can freeze a plastic water bottle, and then roll your bare foot over the frozen water bottle. It provides massage and ice, which will decrease the inflammation and will numb the pain temporarily. Do this for a few minutes at a time at most.

Consider orthotics: There are orthotics, or inserts for your shoe, that provide more stability for your arch. You can try basic orthotics from a drugstore or consider custom orthotics. A physical therapist, podiatrist, or orthotist can help you with custom orthotics.

**If your pain does not get better, consult a physical therapist! There are many other factors that contribute to plantar fasciitis that your physical therapist may be able to assess and treat.

This blog was specially written by our friend and guest writer Rachel Zimmerman, DPT.

Rachel is clinic director at ATI Physical Therapy right here in Green Bay, WI. You can find out more about her clinic or find a location near you at ATIpt.com!

Stress Incontinence? Don’t Worry. Pee Happy!

Have you ever experienced urine leakage while exercising or even coughing?  Do you think it only happens to mothers or females in general?

We are so lucky to have an Ellipse Fitness super hero member whose alter-ego is an expert on the pelvic floor. Veronica Lane, MHS, PT works with women all the time to strengthen their pelvic floor and stop the evil villain, we call, Stress Incontinence in its tracks.

Veronica noticed women heading off to the restroom during activities such as jumping jacks. Some members would joke, “darn kids,” and some coaches who empathize, “happens all the time.”

Lane says, “Yes.  It is common, but it doesn’t have to be tolerated, accepted, or considered a new normal.” Leaking, or incontinence, is not a hopeless result of vaginal births. Similarly, getting up in the middle of the night, at any age, can be resolved.

First, what is the pelvic floor and what does it do?

Confused emoticon

These are the muscles that control urinary and fecal continence.  Strong pelvic floor muscles help to lift the bladder higher in the pelvic cavity, stop the flow of urine, and, along with the anal sphincter, control gas and stool. Poor muscle function can lead to problems with prolapse!

Functions of the Pelvic Floor include

  • Support
  • Sphinteric
  • Sexual
  • Stability

The pelvic floor is part of the core and works with the abdominal cylinder. These muscles need to be able to relax and contract. It is important to build your pelvic floor muscles to support other muscles of the torso.

Stress incontinence is the most diagnosed type of incontinence.  This often occurs when laughing, sneezing, coughing, and participating in physical activity. These activities are directly related to abdominal muscles more commonly referred to when trying to build a six pack.

Do I have to have surgery?

There are some procedures that should be discussed with your doctor. Of course, there are several methods of relief to try in advance of surgery. Lane suggests physical therapy for incontinence, prolapse, frequency, etc. “Conservative treatment should always be the first option!  Also, I still see many women following procedures such as bladder slings. The procedure may fix one problem, but cause another, or maybe it helped the problem(s) without complete resolution.”

Reduce Bladder Irritants

Alcohol*Beer/Wine              Carbonated Drinks*             Caffeine*

*evidence-based

Coffee/Tea (decaf & reg)

Citrus Fruits/Juices             Tomatoes

Spicy Foods                             Sweets                                    Chocolate

Dairy Products                                                                         Artificial Sweeteners

Top 10 Activities  to Increase Bladder Fitness

  1. Go to the bathroom every 3-4 hours or 5-7x in 24 hours
  1. Go for 8 Mississippi’s
  • A full bladder typically takes this long to empty. This can help individuals to determine how full their bladder is when the sensation to go
  1. SIT on the toilet
  • Don’t hover. Yeah. Easier said than done in many public situations!
  1. Go before and after sex
  • Voiding before and after sex is part of the contracting and relaxing process, as well as the cleansing process.
  1. Avoid using the wrong pads
  • Use pads specifically for incontinence. Others can irritate the vagina when worn regularly.
  1. Abdominal strength
  • Participate in exercises that strengthen your abdominal muscles. Try diaphragmatic breathing through a straw, single-leg lowers, and hollow body holds.
  1. Drink plenty of water.
  1. Kegal
  • Correctly! Completely contract. Completely relax. Avoid just squeezing over and over.
  1. Orgasm
  • We will leave the “how” that gets done up to you!
  1. NO “Just in case” urinating, aka JIC-ing. Not even in the middle of the night!

Just In Case Peeing or JIC-ing

JICing pronounce /JIK-ing/ is “just in case” urination. This practice is often supported by society in many ways.  We teach our children from a very early age to go JUST IN CASE before leaving the house, during school, or prior to a sports activity.

JICing trains the bladder to empty before it is full.  JICing regularly will increase the need to go at the first sensation recognized by the bladder. Sometimes that sensation will be laughing, coughing, sneezing, jumping, bracing the abdominal muscles in general, or even riding on a bumpy road.  Ever scurry off to the restroom during a workout because of a strong urge to “GO” yet only to have a few drops?  That is the result of chronic JICing.

The duration between trips to the restroom will also shorten. For example, many people get up in the middle of the night several times to empty the bladder.  Try to avoid going at the first sensation.  Breath and relax to see if the urge passes.  Sometimes habits are so deeply rooted, waking up seems to be normal. This may create some nights of poor sleep.  If we can play the long game, sleep hygiene will only improve.

Lane stresses, “I see a major issue, not as much with weak pelvic floor muscles, but we never ‘let them go’ or relax.  This is common when we have leakage, go too often, and/or have pelvic pain.  Think of bicep muscle.  If we always had our elbows bent and biceps contracted, not relaxed, we would not be able to pick up a gallon of milk.  The biceps would fail.  The same scenario occurs with PF muscles.  If we never let them relax for fear of leaking, going way too often, etc. these muscles will fail when it is time to stop leakage.

We would suggest eliminating just one bladder irritant and adding just one action item in the beginning.  Practice makes permanent. Be patient. Practice. Pee happy!